Transplant candidates with HLA alloantibodies are at high risk for antibody mediated rejection (AMR), graft failure, and acute rejection (1,2). In heart transplantation, these complications lead to death. The 50% CPRA threshold is chosen from a consensus statement from the International Society of Heart and Lung Transplantation (3). This value is admittedly arbitrary but does represent a consensus of accepted opinion amongst experienced and reputable heart transplant centers.